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Dührssen‘s cervical incisions: Forgotten archaic obstetrics procedure?!

Published:December 27, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.12.026
      In 1890, Alfred Dührssen published a paper in which he described cervical incision and extended perineovaginal incision as dilation methods of the soft birth canal. In obstetrics textbooks, this procedure is called Dührssen's cervical incision (DCI), and some authors later give it the name hysterostomatotomy. In the 20th century, this method was gradually discontinued and has now become an archaic obstetric method of academic memory. However, almost all relevant obstetric textbooks mention the performance of DCI. Thus, the world obstetric authorities mention the performance of cervical incision in case of incomplete cervical dilatation during forceps delivery, American authors for cervical spasm after internal version in preterm and breech delivery, and we also described this procedure in our obstetric operations textbook [

      Habek D. Obstetrics operations. Medicinska naklada Zagreb Publisher, 2009; 145.

      ]. DCI is presented as a method to facilitate expulsion of the head in cases of incomplete cervical dilatation in cases of obstructed labor in emergencies due to impending asphyxia (usually when the dilatation is 6–8 cm), or in cases of cervical spasm in breech deliveries. Bilateral radial incisions with scissors under finger control are recommended at 2 and 10 of the clock (possibly the third at 6 of the clock) to avoid the descending irrigation cervical blood vessels and the resulting hemorrhage, and after the birth of the child, these incisions can be sutured easily and in a controlled manner [

      Habek D. Obstetrics operations. Medicinska naklada Zagreb Publisher, 2009; 145.

      ,
      • Rubovits F.E.
      • Cooperman N.R.
      The role of Dührssen's incisions in prolonged labor.
      ,

      Verma ML, Tripathi V, Singh U, Rahman Z. Salvage from cervical dystocia in third degree uterovaginal prolapse: Duhrssen's incision. BMJ Case Rep 2018; 2018: bcr2017223821.

      ,

      Lachica R, Chan Y, Uquillas KR, Lee RH. Vaginal Delivery After Dührssen Incisions in a Patient With Bladder Exstrophy and Uterine Prolapse. Obstet Gynecol 2017; 129: 689-62.

      ,
      • Basnet T.
      • Thapa B.D.
      • Das D.
      • Shrestha R.
      • Sitaula S.
      • Thapa A.
      Maternal and perinatal outcomes of singleton term breech vaginal delivery at a tertiary care center in Nepal: a retrospective analysis.
      ]. Apart from the recommendations for performing DCI in obstetric textbooks, it is interesting to note that the PubMed database contains only about fifteen papers on DCI. For example, Rubovits et al. described more than 200 cases 70 years ago in which DCI was performed in an era when the percentage of caesarean sections was extremely low and home births were still mandatory, and they recommended the method as reliable, simple, and safe [
      • Rubovits F.E.
      • Cooperman N.R.
      The role of Dührssen's incisions in prolonged labor.
      ]. Verma et al. recently presented a case of third-degree uterovaginal prolapse complicated by fetal head entrapment due to cervical dystocia and fetal distress. DCI of the edematous, highly vascularized cervical prolapse was performed and a healthy newborn was born. The cervix was sutured with minimal blood loss and vaginal tamponade, and the mother recovered well [

      Verma ML, Tripathi V, Singh U, Rahman Z. Salvage from cervical dystocia in third degree uterovaginal prolapse: Duhrssen's incision. BMJ Case Rep 2018; 2018: bcr2017223821.

      ]. Lachica et al. used DCI as a successful method for induced labor at 37 weeks in a patient with bladder exstrophy and uterine prolapse [

      Lachica R, Chan Y, Uquillas KR, Lee RH. Vaginal Delivery After Dührssen Incisions in a Patient With Bladder Exstrophy and Uterine Prolapse. Obstet Gynecol 2017; 129: 689-62.

      ], and Basnet et al. used DCI for two of four retained heads during delivery in breech presentation [
      • Basnet T.
      • Thapa B.D.
      • Das D.
      • Shrestha R.
      • Sitaula S.
      • Thapa A.
      Maternal and perinatal outcomes of singleton term breech vaginal delivery at a tertiary care center in Nepal: a retrospective analysis.
      ].
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      References

      1. Habek D. Obstetrics operations. Medicinska naklada Zagreb Publisher, 2009; 145.

        • Rubovits F.E.
        • Cooperman N.R.
        The role of Dührssen's incisions in prolonged labor.
        Am J Obstet Gynecol. 1955; 69: 1183-1192
      2. Verma ML, Tripathi V, Singh U, Rahman Z. Salvage from cervical dystocia in third degree uterovaginal prolapse: Duhrssen's incision. BMJ Case Rep 2018; 2018: bcr2017223821.

      3. Lachica R, Chan Y, Uquillas KR, Lee RH. Vaginal Delivery After Dührssen Incisions in a Patient With Bladder Exstrophy and Uterine Prolapse. Obstet Gynecol 2017; 129: 689-62.

        • Basnet T.
        • Thapa B.D.
        • Das D.
        • Shrestha R.
        • Sitaula S.
        • Thapa A.
        Maternal and perinatal outcomes of singleton term breech vaginal delivery at a tertiary care center in Nepal: a retrospective analysis.
        Obstet Gynecol Int. 2020; 2020: 4039140